March 2005
This piece of work is a reflective account of my experience of being part of a Problem Based Learning (PBL) group, including how the group tackled the task we were given and my thoughts on how that process has impacted on my first four months on placement as a clinical psychologist in training.
My introduction to the concept of PBL occurred on the second day of the course. We were divided into groups, given a title, some learning outcomes and prompt questions and told to produce a presentation in six weeks time; it all seemed so vague and hard to grasp, a whole new way of learning. I was good at learning the way I did for my undergraduate degree, I knew about going to lectures, reading books and writing essays but this was so different. The title was ‘the relationship to change’, but what did that mean? It didn’t sound like a question that required an answer. I felt disappointed that the first thing we were given to do on the course was so intangible. It all felt so unsafe, with no examples of work from previous cohorts to read for inspiration, no buddy to ask, and my trainee colleagues in various states of anxiety and confusion. The group’s facilitator was also new to the concept of PBL; it seemed that we were to learn alongside him rather than be led by him, which only served to magnify my feeling of anxiety as all I wanted was someone to tell me what to do.
In those early days at the beginning of the course there was something very comforting about being part of a small group and having the opportunity to get to know each other. My group was pulled together by the confusion generated by the task we were set and a shared desire to make sense of it; almost immediately the group members were very co operative and mutually supportive. Everyone appeared to respect each other’s feelings and ideas and we all tried to make a special contribution to the presentation, for example by making props or arranging the rehearsals. Perhaps it was that shared early experience on the course that led us to become such a close group. I know, like and trust my fellow PBL members more than any of the other trainees.
The group developed a circle of change model and some of us invested a lot of time and thought in this, although I found myself surprisingly reluctant to get as involved as the others. Then our facilitator appeared to question our approach, which was very hard for some group members to cope with; there was anger, annoyance and hostility towards
the facilitator and stubbornness about changing. Perhaps it was because they felt insecure and so were clinging to what they wanted to be the right way to continue which made them so reluctant to let go of the model. Being ‘right’ was very important to some of the group; I observed their difficulty in tolerating this.uncertainty and was surprised by this. My own, more detatched, view was there could not possibly be a single ‘right’ answer to the task. Some group members found it easier than others to remain hopeful that we could resolve this task and between us we struggled on.
At times I felt very much part of the PBL Group but at other times I reverted to my usual feeling of being an outsider. Typically I am more aware of the things about me that are different from others than the things we have in common, and judge myself negatively as a result. So in my PBL group I see myself as being the only mum, much older, and lacking in clinical experience compared to the rest, even though these things should mean that I have a unique and valuable perspective. I only really feel part of the group when I have made a contribution that has been accepted and valued by the others, such as when I suggested we role play some of the changes which had happened within our group for our presentation. It was a challenge for me to make this suggestion as I lack the confidence to express my opinions and I’m never quite sure when is the right time to make a comment. What if I interrupt someone, or am ignored? What will the others think about what I have said and what will they think about me for having said it? I felt particularly vulnerable to criticism from the group as my idea meant that the focus of the presentation would shift away from the circle of change model and onto us as group members experiencing change. It was such a relief that my suggestion was heard, appreciated and accepted by the others.
Our presentation went well, but it felt unsettling to be judged when we didn’t know what the criteria were. Although the marks we received were almost exclusively ‘excellent/very good’ I wanted to know how we had done compared to the other groups and was concerned about the two items for which we were marked as ‘good/satisfactory’ or ‘requires revision’ by one evaluator. Looking back I feel that we did really well but at the time those marks knocked my fragile confidence. I was feeling vulnerable as I had been part of something so unfamiliar and it was somehow even more important to do
well. Now I am really pleased with the marks we achieved and regard them as a testament to how well the group worked together.
I was surprised when we were asked to self-evaluate; we should probably have been doing this as we went along but were so busy trying to get things done, it didn’t occur to me to keep on checking if we were doing the ‘right’ thing. Would our presentation have been better if we had been constructively criticising it throughout the process? Or would we have become paralysed by self-doubt and unable to do anything? It was probably most effective on this occasion for the group to proceed in the way it did but in future I hope we will be more questioning about what we are doing, perhaps by adopting a reflective team format to comment on the discussions of the main group.
In retrospect my reluctance to fully engage with the task was highlighted by the fact that I did not throw myself wholeheartedly into it and had actually felt rather disconnected from the whole process. At the time I felt overwhelmed with the new challenges of being on the course, including the long hours I was spending on the train (which I had planned to use to think but actually used to sleep) and the mind-numbing intensity of that first six- week teaching block. I felt there was no space in my head to absorb or reflect on what was happening to me. Looking back I see that I should have found a way to make the space required. I was so used to being fully occupied running my home and looking after my child and husband when I was not at work; my previous jobs had been absorbing but did not require more of me than the actual hours I worked. My family and I are still adjusting to the changes in our lifestyle and my new focus on training to become a clinical psychologist. I am so used to putting their needs before my own but this has to change if I am to survive and complete this course. Now I am determined to establish appropriate boundaries; I know there will be times when I have to be ruthless with my time and attention and that my family will have to become more self-sufficient. But how will I feel if/when they do? I will suddenly become less essential to them and will have to deal with my feelings about this change in status when it occurs.
As I write this reflective account I am searching myself to identify the changes that must have occurred in me as part of the process of this PBL exercise, but can I find them? Am I being resistant to change in myself? Is it too much for me to accept that there was
something in me that needed to be changed and that it did change? Or have I just not changed at all? What if I can’t identify any changes? Does this mean that I am incapable of reflection and will not become a good clinical psychologist? Or is it just that I have not gained any significant insights from this particular task?
I have noticed myself feeling more anxious than usual about other aspects of my life as I have struggled to write this account, it is almost as if the anxiety has contaminated other parts of my life. The struggle to reflect leaves me uncertain, it provokes my feelings of insecurity and low self-esteem, which I usually try to ignore but have to confront when I look critically at myself. I had thought of reflection as being something that happened automatically without it having to be made to happen, although as Jasper (2003) comments ‘fundamental to the concept of reflective practice is that we consciously or
knowingly consider our experiences’, I had not appreciated that reflection was such an
active state of mind. Furthermore, Bennett-Levy et al. (2001) comment that ‘self- reflective work seems to need a minimum requirement of time and absorption, which periods of high stress do not allow’. In retrospect I have not allowed enough time for the absorption to occur and so I should not be surprised that reflection is so hard.
Having gone through the PBL process and reflected as much as I can for this account, is there anything I have done or will do differently as a result?
I did find working co-operatively in a small group useful, which led me to convene a small group of trainees to brainstorm ideas around this PBL exercise.
My realisation of the need for effective boundaries in my home-life has reinforced the importance of these professionally too. I do find it hard to say ‘no’ to people I care about and often give too much of myself to my family which leaves me with insufficient time and space for myself. This may also mean I have a tendency to give too much to my clients for example by letting sessions overrun, which then puts me under pressure with the rest of my work. As a result of this realisation I have become more rigorous with time boundaries when working with clients.
Taking part in this PBL exercise has made me think about how clients may feel alone and confused at times and wish the therapist would provide the answer to their problems. I hope that the support I strive to provide for my clients feels more tangible to them than the support I received from the PBL group facilitator felt to me, although it may be just that intangibility which is needed to help clients think for themselves and make their own decisions.
When I started my training I was so excited, amazed that I had been selected to be on the course and thrilled at the prospect of indulging my passion for psychology for the next three years. Upon reflection I had not really thought about the specific demands the course would make on me apart from that it would be challenging. Now I am very conscious of the importance of looking after my own needs and balancing the demands of the rest of my life, and believe this new awareness will help me to become a better trainee and thus eventually a better clinical psychologist.
REFERENCES
Bennett-Levy, J., Turner F., Beaty, T., Smith, M., Paterson, B. and Farmer, S. (2001). The value of self-practice of cognitive therapy techniques and self-reflection in the training of cognitive therapists. Behavioural and Cognitive Psychotherapy, 29: 203-220
Jasper, M. (2003). Foundations in Nursing and Health care: Beginning Reflective